The Impact of Body Mass Index on Pathological Response and Survival Outcome after Neoadjuvant Chemotherapy in Localized Bladder Cancer

Background: Neoadjuvant chemotherapy (NAC) grants a modest survival benefit in localized muscle-invasive bladder cancer (MIBC). We evaluated the pathological response and survival outcome after NAC in stage II and IIIA MIBC and their correlation with body mass index (BMI).Method: Our retrospective study included stage II (T۲ N۰) and IIIA (T۳ N۰, T۴ N۰, T۱-۴ N۱) MIBC. They received NAC followed by radical cystectomy. The patients were categorized into level I: a BMI of ۱۸.۵ – ۲۴.۹ kg/m۲, level II: a BMI of ۲۵-۲۹.۹ kg/m۲, and level III: a BMI of ≥ ۳۰ kg/m۲.Results: ۱۰۳ patients with localized MIBC were included. The median age was ۶۳ years; ۳۵ patients (۳۴.۰%) belonged to level I, ۴۰ patients (۳۸.۸%) belonged to level II, and ۲۸ patients (۲۷.۲%) belonged to level III. Smoking status was more common in level II (۵۱.۰%) and level III (۳۶.۷%) (P < ۰.۰۰۱). Only ۱۸ patients had ECOG PS ۲, all belonging to level III (P < ۰.۰۰۱). After NAC, the pCR was ۳۴.۳%, ۲۵%, and ۱۰.۷% of level I, level II, and level III (P = ۰.۰۳), respectively. Of ۱۹ patients who passed away, ۱۰ patients belonged to level III and ۶ patients belonged to level II (P = ۰.۰۰۷). For level I, level II, and level III, the disease-free survival was ۲۳.۲ months, ۱۲.۷ months, and ۱۰.۷ months and the overall survival was ۶۱.۹, ۵۲.۳, and ۲۸.۷ months, respectively.Conclusion: Obesity and overweight could be predictive and prognostic markers in localized MIBC. These factors are associated with low pCR after NAC, poor disease-free survival, and overall survival.

Keywords:

Urinary bladder neoplasms , Body mass index , Neoadjuvant chemotherapy